Provider Demographics
NPI:1912132895
Name:DR. ALLISON MOTEN, P.A.
Entity Type:Organization
Organization Name:DR. ALLISON MOTEN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-600-6345
Mailing Address - Street 1:101 NE 3RD AVE
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1162
Mailing Address - Country:US
Mailing Address - Phone:954-600-6345
Mailing Address - Fax:
Practice Address - Street 1:101 NE 3RD AVE
Practice Address - Street 2:SUITE 1500
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1162
Practice Address - Country:US
Practice Address - Phone:954-600-6345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7569103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty